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AQUA Registry Data Snapshot: How Has the Utilization of Intravesical Chemotherapy after TURBT Changed over Time?

By: Daniel Lee, MD, MS | Posted on: 03 Sep 2021

The recurrence rates for nonmuscle invasive bladder cancer (NMIBC) can be as high as 70%.1 Meta-analyses have shown that giving intravesical chemotherapy within 24 hours of transurethral resection of bladder tumor (TURBT) can improve the recurrence-free survival rate by 38%.2 However, survey studies have found that compliance rates for postoperative administration can be as low as 20%–30%.3–5 Real-world evidence of national practice patterns are lacking.

Verana Health, the data partner of the AUA Quality (AQUA) Registry, evaluated how intravesical chemotherapy is given after TURBT in a nationwide registry. AQUA Registry data were used to measure the rate of intravesical administration of gemcitabine or mitomycin C within 24 hours of the initial TURBT date. An evaluation of 206 practices from January 2015 to December 2020 found very low utilization rates of post-TURBT intravesical chemotherapy.

Over the 5-year period, 3.1% of initial TURBT cases received intravesical chemotherapy (see figure). In 2015, the rate was 0.9%, which increased to 6.5% in 2020. The decreased number of TURBT overall in 2020 reflected what was seen during the COVID pandemic. This represents a very low percentage for what is considered an established guideline for NMIBC care. Further investigation is needed to find ways to potentially improve this rate among practices participating in the AQUA Registry.

Figure. TURBT and intravesical chemotherapy use (2015–2020).
  1. van Rhijn BWG, Burger M, Lotan Y et al: Recurrence and progression of disease in non-muscle-invasive bladder cancer: from epidemiology to treatment strategy. Eur Urol 2009; 56: 430
  2. Perlis N, Zlotta AR, Beyene J et al: Immediate post–transurethral resection of bladder tumor intravesical chemotherapy prevents non–muscle-invasive bladder cancer recurrences: an updated meta-analysis on 2548 patients and quality-of-evidence review. Eur Urol 2013; 64: 421.
  3. Palou-Redorta J, Rouprêt M, Gallagher JR et al: The use of immediate postoperative instillations of intravesical chemotherapy after TURBT of NMIBC among European countries. World J Urol 2013; 32: 525.
  4. Cary C, Militello L, DeChant P et al: Barriers to single-dose intravesical chemotherapy in nonmuscle invasive bladder cancer–what’s the problem? Urol Pract 2021; 8: 291.
  5. Barocas D, Montie J, Bradford T et al: 56 Practice-based collaboration to improve the use of immediate intravesical chemotherapy (IVC) for non-muscle-invasive bladder cancer. J Urol, suppl., 2013; 189: e23.